Are Neurologists Respected?

Discussion in 'Neurology' started by blindsight, Feb 11, 2004.

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  1. blindsight

    blindsight Banned Banned

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    Feb 8, 2004
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    I have gone to several information sessions about Neurology. Most of the neurologists say that the "know everything, do nothing" stereotype about neurology is no longer true. They say that there are a lot of treatments available now and are developing that make neurology a good field to go into.

    On the other hand, I have never heard of a non-neurologist say anything good about neurology. I have a physician sibling and she flat out told me that she doesn't respect the neurologists that she works with. She says they don't know much. Some friends who shadowed physicians say that a lot of physicians dump patients to neurology when they can't do anything with them.

    So my question is: Has neurology changed for the better? Are there real procedures available in neurology? I am not interested at all in treating headaches or doing sleep related things. Secondly, are neurologists respect anywhere? Granted, my sample is small (2 people) but I have not heard any good things.

    Thank you in advance for your response.
     
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  3. Kalel

    Kalel Banned Banned

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    Neuro definitely has the reputation that you mentioned among older physicians because in the past, it was true. I'd say that it's still partially true for a lot of neurology now, but it's definitely improving with things like thrombolytics being used in early CVA patients and immuno-modulators being used for some of the autoimmune or demyelinating diseases. When you consult neuro for a lot of stuff though, their notes tend to be long, with extensive physical exams, and a lot still offer very little in the way of help (eg continue aspirin, get head MRI, follow up in stroke clinic), so I have noticed that some residents still have these stereotypes about neurology too. I guess my only advise would just be to ignore these stereotypes among your colleagues, *every* specialty has it's own stereotypes and is made fun of by members of other specialties for a wide variety or reasons. As far as procedures go, there is another thread in this forum that has a neurologist arguing with a radiologist about neurologytaking over interventional neurology for the administration of some of the thrombolytics. Some neurologist also do neuromuscular stuff which requires some "procedures" like biopsying and running EMG's. You can also run a sleep lab, even though that's not a real procedure. The other procedures are similar to medicine procedures.
     
  4. neurologist

    neurologist En garde Moderator Emeritus 10+ Year Member

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    Mmmmmmmmmmmm, sort of. You need to accept that while there are lots of new treatments available for neurologic disease, it is quite true that we aren't flat out curing much. But then again, how many hypertensives, diabetics, CHF-ers, etc are our medicine colleagues curing? With the exception of some infections and some surgically addressable conditions, all of medicine is largely a holding action against the inevitable. Anyone who tells you neurologists "don't do anything" needs to take a good look at what they themselves are accomplishing in the long run.


    Maybe your sister just doesn't hang out with very good neurologists. Most of the ones I know are pretty damn smart. Sure, they can't tell you everything about every illness in the world, but who can? Don't forget, we only do 1 year of general medicine training. How much does your sister know about neurology?
    As for the patient dumps, yes they do exist. I get a lot of consults that leave me wondering "why does this person need a neurologist?" The real reason is because the referring physician is either a) not sure if the patient has a neurologic disease because they don't know enough about neurology to make a diagnosis or even ask the right questions (a common problem with patients who eventually get diagnosed with MS, epilepsy, myopathies, etc), or b) too lazy or unmotivated to treat the patient themselves or expend any effort to learn how to treat them, even though it's not all that hard (a common problem for patients with headache or other chronic pain problems).

    Neurology has definitely changed for the better. However, it NOT a procedure-oriented specialty. Spinal taps, EMG, and EEG is about it for most neurologists. If you are looking to do procedures on healthy people, go be an orthopedic or plastic surgeon. Neurology deals for the most part with long term medical management of chronic disease. As far as the respect issue goes, I think most people in the medical field actually do respect neurologists, if for no other reason than we know all that weird neuroanatomy that everyone else choked on in med school.
     
  5. blindsight

    blindsight Banned Banned

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    Feb 8, 2004
    east of eden
    Thank you for the above replies. It seems that Neurologists are still dealing with respect issues, whether fairly or not.

    Just to answer some of your questions, my sister worked at UCLA Medical Center. I'm sure her opinions of her Neurology colleagues were not due to any unusual lack of quality on the part of the Neurology program there. It seems to me that if her opinion of Neurologists at UCLA (a solid, highly respected hospital) are low, there is probably a systemic problem, not just a regional one. However, you raise a good question about how much she knows about Neurologists. She is a hospitalist in Internal Medicine. She never claimed to know much about Neurologists, but just told me her opinion of them without qualifying whether they were justified or not.

    I have a few additional questions, if I may pick your brains a bit more. My interest in Neurology is mainly due to my interest in undergraduate Neuroscience courses. I'm interested in the conversion of sensory input to action potentials, and the decoding and synthesizing process in the brain, both functionally and biochemically. For example, I'm interested in how visual stimuli are coded by the various layers and areas of the visual cortex, and how meaning is generated in the "consciousness" and what underlying biochemical changes guide them. These are the kind of things I'm very interested in. Would a specialization in Neurology deal with any of these type of things? I realize opportunities for learning about these things will be limited in clinical practice, but how about academia?
     
  6. Kalel

    Kalel Banned Banned

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    I have noticed that most of the electrophysiological studies and cortical mapping studies using things like fMRI and PET scans tend to have PhD's as their PI's. Neurologist's tend to focus on research involving treating and diagnosing neurologic diseases. I'm certain that there are many exceptions though, and ultimately, you do choose your own research focus in academia. I did some neuroscience research as an undergraduate as well and thought that I might like to go into neurology or neurosurgery, but ultimately, I discovered that I did not like neurology as a specialty because of many of the previous things that I noted in my previous post here and that I don't like being in the OR or doing procedures; so I would just encourage you to keep an open mind about your specialty choice.
     
  7. Docxter

    Docxter Senior Member 7+ Year Member

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    The bottom line is you will respect neurologists when as a patient, you or a loved one has a neurological disorder, or alternatively, as a physician, you need help or consult on a neurological problem. The same goes for all specialties. Everybody has their own place in the spectrum of medical specialties. All specialties are needed. I am not in neurology myself, but work with neurologists quite frequently and the ones that I deal with are very knowledgeable and repectable colleagues.
     
  8. tofurious

    tofurious Senior Member 7+ Year Member

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    What specialty is your sister in? UCLA Neurology has the largest NIH funding among neurology departments, and they are at the forefront of becoming interventional among all neurology departments.
     
  9. blindsight

    blindsight Banned Banned

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  10. tofurious

    tofurious Senior Member 7+ Year Member

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    I don't think she is aware of what is going on even at her hospital. That is the sad fact of life: non-neurologists still hold a 70s view of neurology, while neurology has not only undergone the evidence-based medicine transformation but also a basic and clinical scientific revolution.
     
  11. blindsight

    blindsight Banned Banned

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    Feb 8, 2004
    east of eden
    You are probably right. All she said was that she did not respect them, she didn't elaborate on why. When I pressed further she didn't have a real reason. My guess is that this opinion is something she picked up from attendings or others. I too think it is sad.
     
  12. Vader

    Vader Dark Lord of the Sith Moderator Emeritus 10+ Year Member

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    I tend to be of the camp that believes neurology is an excellent field for people interested in discovering the inner workings of the nervous system. Of all specialities, neurology is perhaps the most academic in nature, very amenable to both clinical and basic research.

    It is true that there are many new treatments available that can help patients. That and with modern imaging techniques, the field has undergone quite a revolution. The explosion in neuroscience research during the 90's will surely translate into additional new therapies. So there is much to be excited about.

    Having been on rounds with UCLA neurology residents, I cannot see what your sister was talking about. From my perspective, the residents seemed like extremely intelligent, thoughtful, energetic people who also were quite friendly and outgoing. They seemed to make the attending's work easy by anticipating and solving patient problems. They also treated the medical students on the team quite nicely as well--one got the sense that they enjoyed teaching very much.

    Certainly, the field is not for everyone. One usually gets a good sense of the daily activities of a neurologist while on the clinical clerkships and subinternships.
     
  13. Neuron

    Neuron Aequanimitas. 7+ Year Member

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    Blindsight: very interesting question.

    I think the way neurologists are viewed by other medical specialists has varied widely over time, and today still varies to a smaller extent on place of practice.

    In the old days (ie. late 19th century until 1960s-70s) neurologists were generally been viewed as highly intellectual, if commonly ineffectual, colleagues.

    These were the people you turned to when faced with any patient with any sort of problem anywhere in the nervous system that you couldn't make head or tail of. This was what would often happen:

    He (and it was almost always a he) would turn up, sometimes after an unconscionably long period of time, proceed to politely take a thorough history, do an extremely detailed (and, if you bothered to watch him do it, sublimely elegant) examination, make subtle observations about all kinds of things no other medical consultant would have noticed if they had watched the patient twice as long, chuckle briefly, nod his head sagely, tell you the patient had something you'd never heard of in your entire life - named after 5 European guys you swear no one else anywhere had ever heard of in their entire lives - and to prove it, suggest a test (yes, just one) you didn't quite think was as important to get quite so soon.

    Days later the test would come back positive (but of course), and you'd happily tell the neurologist when you next saw him in the hallway that he was right. He'd be somewhat surprised you felt this was news, but just thanks you - politely - once more for the "very interesting" consult.

    He is about to walk on, when you tug at his sleeve and say "Umm, so what're you going to do?" He looks genuinely surprised at first that there should be something more to do, but then looks at you with grave eyes and mutters something about "outcomes not being very promising" in "these cases". If you'd "send her down to my clinic when she's discharged, I'd be happy to follow her along, of course".

    That evening, long after everyone else had left, you see him chug off in his ancient Ford, after enough tinkering about in his lab for the day.

    ~~~~~~~~~~~~~~~~
    Or something like that. And so the legend grew about the neurologist not being able to able to do anything much, though he certainly knew an incredible amount of medicine.

    These days, many things have changed. But some things have still remained the same.

    Neurologists can do a little more these days. A little clot busting here, a little immunosuppresion there. A few more functions preserved for their patients, a few more months or years of life. With luck, maybe fewer of those years are spent in a nursing home. Better pain control.

    But so much still cannot be cured. A lot of other specialists unfairly (and stupidly) seem to think that this is somehow neurologists "fault". That they can't be of much use because they can't seem to really do anything.

    This sort of thinking ignores a couple of important things.

    Firstly, there's a whole bunch of diseases out there - in all specialties - that you just don't have any chance (currently) of curing. But not being able to cure does not mean not being able to help. To help a dying or suffering individual to any small extent is not a bad thing, and patients appreciate that.

    Second, neurologic disease is usually bad stuff, no matter how you look at it. Having a smart guy figure out that you really do have an incurable problem and not a rare but treatable disease is also not a bad thing.

    Thirdly, the reason so much of neurology is incurable has to do with the brain (duh). Of all things in medicine, the brain is what we understand the least. We don't understand even the very basics of how the brain functions, let alone the etiopathology of its diseases. Every other organ (and every other specialist) deals with an infinitely easier system. You can understand very easily how the heart works, from the physics to the chemistry, to a lot of the molecular biology. The thing is basically a pump. You can understand how the kidney works, from the molecular biology through the cellular and tissue level to the systems level. The thing is a filter and a fluid regulator.
    But can you tell me how the brain works? How does a bunch of neurons produce your thoughts? your sense of self as a person, your behavior, your memories, emotions? How does your brain process pain? The other sensations? Heck, how does a bunch of neurons produce you?

    How are these cells made? Are they renewed continuously, like the skin and gut? What controls them? If you could renew them, would they form their own circuits? What regulates those? What about transmitters?

    We don't know BASIC stuff about the brain, how it works, how it can go wrong, how to repair it when it does. And this is not for lack of trying. It's just that the brain is just really hard (duh).

    But with the incredible research going on, this is changing everyday. In the meantime, neurologists do their best. Sometimes however, that doesn't amount to much, from other specialists point of view.
     
  14. blindsight

    blindsight Banned Banned

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    Thanks for the story. That was a good read. :) It's interesting that you bring up the part I quoted above... these are exactly the types of questions I'm interested in researching. However, I'm not so sure that neurology will help me answer any of these things. I'm constantly wondering if I should have gone to graduate school in neuroscience or neurobiology. :(
     
  15. Vader

    Vader Dark Lord of the Sith Moderator Emeritus 10+ Year Member

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    Neurology can tell you quite a bit about how the brain works. Most of the original insight into localization of function within brain areas was elucidated through lesion studies--patients who had strokes, tumors, or traumatic injury to various parts of their brains and the resulting deficits. The famous neurologist Broca, for example, identified area 44 as being critical for language production by studying his patient "Tan".

    Much of our exisiting insight into basal ganglia function has stemmed from studies of patients with disorders that affect discreet components of its complex circuitry: Huntington's and Parkinson's patients, for example.

    Family studies and genetic linkage analysis to identify the genes responsible for neurological disorders is a great way to integrate a clinical and scientific interest. Genes for Huntington's, Parkinson's, Alzheimer's, etc have been discovered in this manner.

    If you haven't, you should read "The Man Who Mistook His Wife For A Hat" by neurologist Oliver Sacks. In it you will find the most amazing behavioral disorders and the lesions in the nervous system that cause them. But more significant is the approach to studying the brain highlighted here: as physician-scientist, you can learn quite a lot about how the brain works from your patients.
     

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